Acupuncture

Rating

Category: Complementary and Alternative Therapies

Injury Type: Acute

What is it?

Acupuncture is a treatment modality of Traditional Chinese Medicine (TCM) which dates back thousands of years in China. Acupuncture treatment involves the insertion of fine, sterile needles into specific sites (acupuncture points) along the body's meridians (a network of invisible channels through the body), which purport to clear energy blockages and encourage the normal flow of qi or "life energy" through the individual. The practitioner may also stimulate the acupuncture points using other methods, including moxibustion, cupping, laser therapy, electro-stimulation and massage, in order to re-establish the flow of qi.

How does it work?

Animal and human studies have demonstrated that acupuncture may cause multiple biological responses. These proposed changes include influencing the nervous system, neurotransmitters and endogenous substances which respond to needling stimulation and electro-acupuncture that influence pain relief and regulation of the nervous system.

From a TCM perspective, it is believed that when the person is in good health, an abundant supply of qi flows through the body's meridians. If the flow of qi in the meridians becomes blocked or there is an inadequate supply, then the body fails to maintain harmony, balance and order, with disease or illness often following. Thus, acupuncture is thought to restore the flow of qi through the body.

Is it effective?

There have been three small studies of the effectiveness of acupuncture following whiplash. Two of which examined the effect of acupuncture on balance following whiplash injury and found that acupuncture helped to improve balance. One low quality study of laser acupuncture, found that it had no effect on symptoms or range of motion in the early and late stages following whiplash injury. A recent synthesis of evidence found that acupuncture was more effective than no treatment or placebo treatments in reducing pain in the short term. It must be noted that this synthesis was not peer reviewed, as per routine process, and hence its findings should be considered with some caution. In contrast, a recent systematic review found that there was not enough evidence to support the use of acupuncture following whiplash injury. Two recent reviews have found that acupuncture had a considerable short term effect on pain and disability in mechanical neck pain.

A randomised controlled trial investigated the effectiveness of acupuncture for treatment of patients with subacute and chronic WAD. The findings from this study indicated that acupuncture treatment was associated with a significant but small reduction in pain intensity over a period of at least six months. Futhermore, the acupuncture treatment had no effect on disability or quality of life measures. Another randomised crossover trial found that one session of acupuncture resulted in improvements in pain pressure sensitivity in the neck and calf of patients with chronic WAD. This study also found that acupuncture was well-tolerated treatment in this group of patients. The authors of this study suggest that acupuncture treatment may activate natural brain-driven pain relief in patients with chronic WAD.

Are there any disadvantages?

Serious adverse reactions to acupuncture treatment are rare. Infrequent minor side effects may include bruising or some discomfort around the site of needling. Acupuncture is safe in the hands of a competent practitioner.

Where do you get it?

Acupuncture should be provided only by an Acupuncturist belonging to a professional association. Acupuncturists can be found listed by their professional association in the Yellow Pages.

Recommendations

The use of acupuncture as an adjunct to other therapy, in treating mechanical neck pain, may be considered for short term relief of pain and disability. However more research is required in order to recommend its use as a sole intervention and to determine its long term effects.

Key References

  • Aigner, N, Fialka, C, Radda, C & Vecsei, V 2006, 'Adjuvant laser acupuncture in the treatment of whiplash injuries: a prospective, randomized placebo-controlled trial', Wien Klin Wochenschr, vol. 118, no. 3-4, pp. 95-99.
  • Cameron, ID, Wang, E & Sindhusake, D 2011, 'A randomized trial comparing acupuncture and simulated acupuncture for subacute and chronic whiplash', Spine, vol. 36, no. 26, pp. E1659-E1665.
  • Fattori, B, Borsari, C, Vannucci, G, Casani, A, Cristofani, R, Bonucelli, L & Ghilardi, PL 1996, 'Acupucture Treatment For Balance Disorders Following Whiplash Injury', Acupuncture and Electro-Therapeutics Research International Journal, vol. 21, pp. 207-217.
  • Fattori, B, Ursino, F, Cingolani, C, Bruschini, L, Dallan, I & Nacci, A 2004, 'Acupuncture treatment of whiplash injury', International Tinnitus Journal, vol. 10, pp. 156-60.
  • Guzman, J, Haldeman, S, Carroll, L, Carragee, E, Hurwitz, E Peloso, P, Nordin, M, Cassidy, D, Holm, L, Coˆte, P, Van der Velde, G & Hogg-Johnson, S 2008, 'Clinical practice implications of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders; from concepts and findings to recommendations', European Spine Journal, vol. 17, no. 1, pp. 199-213.
  • Guzman, J, Haldeman, S, Carroll, LJ, Carragee, EJ, Hurwitz, EL, Peloso, P, Nordin, M, Cassidy, JD, Holm, LW, Côté, P, Velde, G & Hogg-Johnson, S 2009, 'Task force on neck pain and its associated disorders', Journal of Manipulative and Physiological Therapeutics, vol. 32, pp. 227-243.
  • Hurwitz, E, Carragee, E, Van der Velde, G, Carroll, L, Nordin, M, Guzman, J, Peloso, P, Holm, L, Coˆte, P, Hogg-Johnson, S, Cassidy, D & Haldeman, S 2008, 'Treatment of neck pain: noninvasive interventions; results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders', European Spine Journal, vol. 17, no. 1, pp. 123-152.
  • Leaver, AM, Refshauge, KM, Maher, CG & McAuley, JH 2010, 'Conservative interventions provide short-term relief for non-specific neck pain: a systematic review', Journal of Physiotherapy, vol. 56, pp. 73-85.
  • Mercer, C, Jackson, A & Moore, A 2007, 'Developing clinical guidelines for the physiotherapy management of whiplash associated disorder (WAD)', International Journal of Osteopathic Medicine, vol. 10, no. 2-3, pp. 50-54.
  • Tobbackx, Y, Meeus, M, Wauters, L, De Vilder, P, Roose, J, Verhaeghe, T & Nijs, J 2012, 'Does acupuncture activate endogenous analgesia in chronic whiplash-associated disorders? A randomized crossover trial', European Journal of Pain, vol. 17, pp. 279-289.
  • Verhagen, A, Scholten-Peeters, G, Van Wijngaarden, S, De Bie, R & Bierma-Zeinstra, S 2007, 'Conservative treatments for whiplash', Cochrane Database of Systematic Reviews, Issue 2, Art. No.: CD003338. DOI: 10.1002/14651858.CD003338.pub3.
Copyright © Centre of National Research on Disability and Rehabilitation Medicine (CONROD)